Current opinion in pulmonary medicine
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Malignant pleural effusions (MPEs) are one of the most common problems faced by clinicians and, since there is no optimum treatment available, they deserve efforts aimed to improve their management. ⋯ The above results may contribute to improve significantly management of patients with malignant pleural effusions, especially those with advanced disease who are not suitable for pleurodesis procedures.
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Tunneled pleural catheters (TPCs) have become a popular therapeutic tool for chronic pleural effusions. Although the main indication for a TPC has been recurrent, symptomatic, malignant pleural effusion, there are increasing reports of TPC usage in other medical conditions. This article will address the utility of TPCs in malignant pleural effusions, other reported uses, potential complications and catheter maintenance. ⋯ TPCs are an effective management strategy for symptomatic, recurrent, malignant pleural effusions. Their use as a first-line treatment is feasible and TPCs are particularly preferred for patients with trapped lung or those who are not considered good candidates for chemical pleurodesis because of short life-expectancy. There currently lacks sufficient evidence to recommend the use of TPCs in nonmalignant pleural diseases.
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The field of interventional bronchoscopy has seen an evolving need for different types of anesthesia for various procedures. This review describes recent advances in the field of anesthesiology that have increased the suitability of conscious sedation under monitored anesthesia care or general anesthesia for prolonged and complex interventional bronchoscopic procedures, especially those performed on severely ill patients. Additionally, the pros and cons of performing bronchoscopic procedures in the bronchoscopy suite versus the operating room are analyzed. ⋯ Interventional bronchoscopists are encouraged to examine the pros and cons of different types of anesthesia for various bronchoscopic procedures.
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Thoracentesis is a common bedside procedure associated with iatrogenic complications including pneumothorax. Experienced clinicians using optimal procedural techniques within a supportive system can achieve improvements in safety. However, clinicians have been relatively slow to adopt these changes. This review examines the available literature regarding procedural safety of thoracentesis with emphasis on best practice models to reduce iatrogenic complications. ⋯ Several procedural modifications have led to improvements in thoracentesis procedural safety in reducing iatrogenic complications. Herein, we review the known risks associated with thoracentesis and identify the modifiable and nonmodifiable risk factors. On the basis of recent studies, we make recommendations and encourage incorporation of 'best practice' techniques for thoracentesis procedures.
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Cystic fibrosis (CF) is a complex genetic disease affecting many organs, although 85% of the mortality is a result of lung disease. The natural history of the lung disease consists of early and persistent infection, an exaggerated inflammatory response, structural airway changes (i.e. bronchiectasis), and progressive airways obstruction, ultimately resulting in respiratory failure. As airways disease worsens, there is an increased likelihood of respiratory complications, such as pneumothorax, that may be serious. This review describes our current understanding of the pathogenesis of pneumothorax in CF and its treatment. ⋯ We now have recommendations on specific care of the patient with CF who has a pneumothorax.